Physio-pathology of Hydrocephalus and nuances of administration of Anesthesia

1. HYDROCEPHALUS
Speaker: Dr Bhagirath.S.N
Moderator: Dr Sarika

2. Hydrocephalus
Causes
1. After closure of meningomyelocele (if
chiari II malformation is present)
2. Congenital (aqueductal stenosis)
3. Intraventricular hemorrhage
Neonate
1. Cranial sutures are open-so pressure
increases are blunted
2. But eventually, head increases in size and
intra cranial pressure increases

3. Hydrocephalus
Clinical presentation
1. Lethargy
2. Vomiting
3. Cardio respiratory problems
Anesthetic Technique
1. Avoid increase in ICP secondary to awake tracheal
intubation, crying, struggling, straining
2. Rapid sequence induction is preferred
3. Volatile anesthetic agents, opioid and nitrous oxide are not contraindicated.
(Ketamine, Isoflurane, fentanyl)
4. Open-sutured cranium means there is no increase in intra cranial pressure
secondary to Ketamine and volatile anesthetic administration.
5. Extubation depends on whether periods of intraoperative apnea & bradycardia
were seen.

4. Hydrocephalus
Management
•Surgical-Ventriculo-peritoneal shunt